ES2358983T3 - ANCHORAGE WITHOUT KNOTS FOR FABRIC. - Google Patents

Abstract

An anchor (40) without knots for tissue, comprising: an expandable member (12) defining an bore (15) therethrough and including a part (18) that can expand radially; an inner member (24) disposed to slide in the bore of the expandable member such that the expandable portion expands radially outward in response to a longitudinal movement of the expandable member relative to the inner member; a suture segment (40) having a first end (42) and a second end (48), the first end of the suture being fixed to the distal end of the inner member; and characterized in that the second end of the suture segment is fixed to a surgical needle (46) intended to pass the suture through a tissue, and a distal part of the inner member is provided with a transverse hole (50) with a diameter intended to allow the surgical needle and the suture to pass through it in order to secure the tissue adjacent to the distal end of the inner member.

Description

BACKGROUND:

1. Technical field

The present exhibition refers to knotless anchors for suture and tissue and, more particularly, radially expandable anchors.

2. Related prior art

During a surgical operation it is often necessary to attach prosthetic implants or soft tissue, such as muscle tissue, ligaments or tendons, to hard tissue such as bone. Various types of surgical fasteners or fasteners are used to achieve this function, including clips, screw and washer systems, suture anchor devices and tissue anchors.

The first of these types is illustrated in US Pat. Nos. 4,454,875 and 4,570,623, which show metal clips with nails on the underside of the crosspiece to secure the ligaments.

The fasteners or fasteners included in the second of these types are available as screw-washer combinations, in which the screw is made of a surgically suitable metal, such as titanium or stainless steel alloy and usually has a design self-tapping The suture anchors are intended to be inserted in holes previously drilled in the bone and may be made of bioabsorbable material. When a ligament or suture is secured within a hole drilled in a bone, self-tapping screws can subject the ligament or suture to abrasion when they are being screwed.

Suture anchors are also used to pull tissue adjacent to a bone. The anchor, which has a first end and a suture attached to it, is anchored in the bone and a second end of the suture is sewn through the bone and tied with a knot to secure the tissue to the bone.

Extensible fasteners or fasteners for tissue, intended for use in minimally invasive surgical procedures (for example, arthroscopic procedures) are used, for example, in the repair of shoulder and knee injuries. In such procedures, the surgical instruments are usually deployed through a long and narrow cannula inserted through a small incision in the skin. Typically, the suture knots are tied away and pushed down, to the anchor, to secure the tissue and site.

WO 95/15726 describes a fastener or bone fastener. The US document

5,928,244 discloses an apparatus for applying a fastener or fastener for tissue in order to fix soft tissue to a bone. US 5,464,427 describes an suture anchor. Document FR 2 784 020 describes an implant for the repair of a ligament. The preamble of claim 1 is based on WO 95/15726. WO 01/10312 describes an suture anchor. This document was published after the priority date of the present application, but claims an earlier priority date and therefore falls within the terms of Article 54 (3) of the EPC.

What is needed is an anchor or expandable clamping device or fastener for tissue, to secure bone-free knots and to ensure non-traumatic bone grafting, especially in minimally invasive surgical procedures.

SUMMARY

According to the invention, a knotless anchor for tissue is provided as defined in independent claim 1, which includes an expandable member defining an bore therethrough and having a radially expandable portion. The expandable member may also have an enlarged head part. Preferably, the radially expanding part includes at least two distally extending branches, which define a pair of grooves between them. The fabric anchor also includes an inner member arranged so that it can slide into the bore of the expandable member and that has a cam action surface that can be applied with the distal ends of the branches to radially force outwardly to the ends. distal to the branches in response to the distal movement of the expandable limb relative to the inner limb. The inner member also includes a suture segment that has a first end fixed to the distal end of the inner member and a second free end and whose second free end is fixed to a surgical needle to pass the suture through the tissue. Preferably, the suture segment extends distally from the distal end of the inner member. More preferably, the second end of the suture is fixed to a double pointed surgical needle or a surgical incision member, configured to pass the suture through the tissue. It is important that a distal end of the inner member is provided with a transverse hole of sufficient diameter to allow the surgical needle and the suture to be passed therethrough in order to secure the tissue or a length of ligament adjacent to the distal end of the internal member

The proximal end of the inner member may be provided with an enlarged head for application within a mounting member associated with an implantation apparatus and to be retained therein. In addition, the inner member may be provided with a plurality of fins configured to slide into the grooves defined between the branches of the outer member and guided by them. In a stem section of the inner member, crests may also be provided in order to prevent distal movement of the inner member relative to the expandable member once the branches have been expanded. Finally, the inner member may also be provided with a breakage notch such that, when the branches of the expandable member are fully expanded, the notch is broken and part of the inner member is torn off to leave the surface of the tissue anchor flush of the bone

A mounting member is also provided configured to receive, in a releasable manner, the fastener or fastener for tissue described and to be detachably mounted in an implantation apparatus.

Likewise, an illustrative method for securing, without knots, a section of tissue to a bone is described, but the method is not cited in the claims and is not part of the invention. This is particularly advantageous in surgical operations such as those performed in the repair of ligaments or muscles in the shoulder. The method generally includes providing the fastener or fastener for tissue described, which has an expandable outer member that defines an bore and the internal member movably mounted within this outer member. In addition, a suture segment attached to the distal end of the inner member and having a suture needle at the opposite end of the suture is also provided. The method also includes the operations of passing the free end of the suture through the tissue to be held. Preferably, this is achieved by a suture instrument used to pass the surgical needle through the tissue. Then, the tissue fastener or fastener, with the tissue section attached to it, is positioned in a hole formed in the bone while the tissue section is outside the bone. In addition, the suture segment that extends from the distal end of the inner member is also positioned in the hole formed in the bone and that extends parallel to the tissue fastener or fastener and out of the hole. The expandable member expands by carrying the expandable member distally relative to the inner member so as to expand the expandable member by applying it with the suture and against the bone. The method may also include the operation of passing the free end of the suture through a transverse hole at a distal end of the inner member after the suture has been passed through the tissue, to secure the tissue together to the distal end of the inner limb. Once the suture has been passed through the transverse hole, tension may be applied to the suture to pull the tissue adjacent to the hole drilled in the bone.

An illustrative method of securing a ligament within an elongated hole drilled in the bone is also described, as used in knee repair surgery but, likewise, this method is not part of the invention. The method includes providing the tissue fastener or fastener described herein and piercing the ligament one or more times with the needle attached to the suture. Then, the needle and the suture are passed through the hub into a transverse hole at the distal end of an inner member of the tissue fastener or fastener and the ligament is tightly secured next to the distal end of the inner member. In addition, the suture can be wrapped several times around the ligament and the distal end of the inner member, thereby securely attaching the ligament to the distal end of the inner member. The fastener or fastener for tissue is provided with a mounting part for attachment to an implantation apparatus or can be assembled manually on a mounting member that is then mounted so that it can be disassembled on an implantation member.

Once the ligament and the fastening device or fastener for assembled tissue have been mounted in the implantation apparatus, it can be inserted through an enlarged hole formed through a pair of knee bones. The holes have a sufficient diameter so that the associated ligament is not subjected to abrasion or destroyed as it is advanced through the enlarged hole. Preferably, at the most distal end of the holes, a reduced diameter section is provided to receive the tissue fastener or fastener and the associated ligament. Then, the implantation apparatus is operated to expand the expandable member thereby compressing the ligament adjacent to the bone orifice wall in order to secure the ligament between the expandable member and the bone. In this way, the ligament can be implanted solely by radially directed forces acting on the ligament, thus providing nontraumatic delivery and fixation of the ligament within the knee bone.

BRIEF DESCRIPTION OF THE DRAWINGS

In the following several embodiments are described with reference to the drawings, in which:

fig. 1 is a perspective view, with separate parts, of a preferred embodiment of a radially expandable tissue fastener or fastener, which includes an associated suture segment and a needle, and a mounting part for use with an implantation device ;

fig. 2 is a cross-sectional view of the fastener or fastener for assembled tissue, in the non-activated state;

fig. 3 is a cross-sectional view of the fastener or fastener for tissue mounted, in activated, radially expanded state;

fig. 4 is a cross-sectional view of the fastener or fastener for tissue loaded in the mounting portion, to form a disposable loading unit;

fig. 5 is a perspective view of the disposable loading unit mounted on an apparatus for implanting a fastener or fastener for tissue and the associated needle mounted on a jaw of a suture apparatus;

fig. 6 is a side view of the jaws of the suture apparatus by passing the needle through a section of tissue to be fixed to a bone;

fig. 7 is a side view of the suture instrument that has passed the needle through a hole in the tissue fastener or fastener;

fig. 8 is a cross-sectional view of the fastener or fastener for non-activated tissue, positioned in a hole drilled in a bone;

fig. 9 is a cross-sectional view of the fastener or fastener for tissue in the hole formed in the bone, in an activated state, to anchor both ends of the suture therein;

fig. 10 is a cross-sectional view taken along line 10-10 of fig. 9;

fig. 11 is a side view of a piece of ligament or graft material that has been pierced by the needle and suture associated with the tissue fastener or fastener;

fig. 12 is a partial cross-sectional view of the graft material secured to one end of the tissue fastener or fastener;

fig. 13 is a perspective view of a fastener or fastener for assembled tissue and graft material mounted in the implantation apparatus and positioned in a hole drilled in the bone; Y

fig. 14 is a partial cross-sectional view of the fastener or fastener for expanded tissue, securely attaching a first end of the graft material into the bone hole.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Preferred embodiments of the apparatus described herein are described in terms of the implantation of an expandable orthopedic fastener or brace for tissue. However, it is also intended that the apparatus be applicable to a wide variety of procedures including ligament repair, joint repair or replacement, non-union fractures, facial reconstruction, etc., but not limited to these. Furthermore, it is believed that the present apparatus finds application in both open procedures and minimally invasive procedures, including endoscopic and arthroscopic procedures in which access to the area of operation is achieved through a cannula or a small incision.

In the description that follows, the term "proximal", as is traditional, will refer to the part of the structure that is closest to the operator, while the term "distal" will refer to the part furthest from the operator.

The device and methods described herein are specifically configured to secure tissue or suture material by applying a radially expandable fastener or fastener for tissue to a hole previously drilled in a bone and securing the tissue or suture between the device. clamp or bra and bone. The orthopedic fastener or fastener for tissue is preferably provided as part of a disposable loading unit that includes a mounting unit.

Referring now to fig. 1, the fastener or fastener 10 for fabric includes an expandable body 12 and an armed pin. More particularly, the body 12 and the spigot are preferably made of a bioabsorbable material such as polymers of glycoside, lactoside, caprolactone, p-dioxanone, trimethylene carbonate and physical and chemical combinations thereof. The body 12 includes a rod 14 with an axial opening 15 extending therethrough. An enlarged head 16 for application with an implantation instrument can be provided at a proximal end of the rod 14.

The stem 14 includes at least two, and preferably four, branches 18 that extend distally, defined by longitudinal grooves 20. The body 12 is made of a material with sufficient flexibility and elasticity to allow the branches 18 to expand radially by opening. out. When the body 12 is inserted into a hole and the branches 18 expand, harpoons 22 provided on the outer surface of the branches 18 are applied with the bone tissue wall of the hole and frictionally secure the body therein. The expanded branches 18 also ensure, without knots, a section of suture or graft material positioned between the branches 18 and the adjacent bone. The branches 18 expand in response to the application with an armed pin 24, as described in the following.

The armed pin 24 forms part of the expandable fastener or fastener 10 for fabric and includes an elongated rod 26 with at least one and preferably four, longitudinally extending fins 28, intended to be applied in grooves 20 of the body 12 and be guided by them. A series of circumferential harpoons 30 on the rod 26 prevent movement in the distal direction of the mounting pin 24 relative to the body 12. The rod 24 also includes a head 32 of larger diameter at its proximal end to facilitate the grip of the pin of assembly 24 by means of an implantation instrument. At its distal end portion, the rod 26 includes a bulbous portion 34 of expanded diameter that includes a cam action surface 36 oriented in the proximal direction and a sharp tip 38 oriented in the distal direction. The cam action surface 36 is intended to be applied with the branches 18 of the body 12 and expand them radially. A first end 42 of an associated suture segment 40 is fixed to the stem 26 within a hole 44 of the tip 38. A needle 46 is fixed to a second end 48 of the suture 40. The needle 46 can be a suture needle known or, preferably, a surgical incision member such as that described in US Pat. 5,569,301 to Granger et al. A transverse hole 50 for receiving the suture 40 is provided in the bulbous portion 38. The rod 26 also includes a proximal end portion delimited by a circumferential break notch 52.

A mounting member 100 is provided for mounting the fastener or fastener 10 for tissue in an implantation apparatus and, together with it, forming a disposable loading unit 150. The mounting member 100 is a part for mounting the device for tissue holder or fastener that constitutes an independent structure to support the expandable body 12 of the tissue fastener or fastener 10 and the assembly pin 24. The entire disposable loading unit 150 is mounted at the distal end of the implant apparatus, as described below.

The mounting member 100 includes a collar 102 defining a recess 104 in which the head 16 of the body 12 is received and supported. A rod 106 defines a longitudinal geometric axis and includes bayonet mounting pins 108 that extend laterally to be applied. releasably in L-shaped grooves of the housing tube of an implantation instrument. A mounting slot 110 for retaining the mounting pin 24 extends longitudinally through the collar 102 and includes at least one support wall 112 for contacting the head 32 of the mounting pin 24 and retaining it. An access opening 114 allows the head 32 to be mounted in the mounting groove 110 in a position proximal to the support wall 112. The mounting member 100 also includes arcuate access chambers 116, which extend longitudinally, which allow passage to its through pusher teeth (described below) to come into contact with head 16 of body 12 and push it.

Referring to figs. 2 and 3, the rod 26 of the armed pin 24 is intended to slide in the opening 15 of the body 12. When the body 12 is moved distally with respect to the armed pin 24, the cam action surface 36 comes into contact, possibly with the distal tips of the branches 18. The further distal movement of the body 12 causes the branches 18 to open radially by virtue of the cam action of the surface 36 due to the diameter of the bulbous part 34 is larger than that of the opening 15. The distal movement of the body 12 can be achieved by means of an instrument that advances the body 12 distally while holding the arming pin 24 stationary, or that grabs the head 32 of the arming pin 24 and pulls it while holding the body 12. At a predetermined point, the branches 18 are fully expanded and the armed pin 24 can no longer move through the opening 15. A force The increased traction exerted on the proximal end portion of the rod 26 causes the rod 26 to break through the break notch 52 by separating the rod 26 from the proximal end portion when a predetermined force is applied. The armed pin 24 is configured and sized such that, when the rod 26 of the armed pin suffers the controlled fracture with the fully expanded branches 18, the break notch 52 will not be located outside the opening 15 of the body 12 , but inside the opening 15.

Referring now to fig. 4, the disposable loading unit 150 is delivered to the surgeon in sterilized form and can be fully assembled, with the fastener or fastener 10 for tissue positioned on the mounting member 100, or the components may be separated, being necessary its assembly

In order to mount the fastener or fastener 10 for tissue within the mounting member 100, the elongated rod 26 of the mounting pin 24 is inserted into the mounting slot 110 in the form of a keyhole of the mounting member 100 .

The elongated rod 26 is advanced into the groove 110 until the head 32 is flexed to a low position, within the groove 110 and rests against the support wall 112. Thus, the head 16 of the expandable body 12 is positioned in a recess 104 of collar 102. In this way, the disposable loading unit is mounted and ready to be inserted into an implantation instrument. The attached suture 40 and needle 46 may be provided loose or in a separate loading unit to facilitate loading of the needle 46 into a surgical suture instrument.

Referring now to fig. 5, there is illustrated a suitable apparatus 200 for implantation of a fastener or fastener for tissue, whose components and operation are described more fully in US Pat. 5,928,244 to Tovey et al. In general, the implantation apparatus 200 includes an elongated part 202 that extends distally from a handle part 204. The handle part 204 generally includes a stationary handle part 206 and a trigger 208. The trigger drive 208 it serves as an operative structure to expand the fastener or fastener 10 for tissue.

A distal end of the elongate portion 202 is provided with an L-shaped groove 210 configured to receive the bayonet mount pins 108 of the mounting member 100. In order to mount the disposable loading unit 150 in an implantation apparatus 200, the mounting member 100 is placed in position and advanced along the distal end of the elongate member 202 such that the bayonet mounting pins 108 enter the elongated groove 210. The mounting member 100 is rotated then such that the bayonet pins 108 are rotated within the transverse portion 212 of the groove 210. Thus, the disposable loading unit 150, which includes the mounting member 100 and the fastener or fastener 10 for tissue , are securely attached to the distal end of the implantation apparatus 200. As noted above, the trigger actuation will activate the expandable member 12 distally relative to the spi assembly arm 24 to expand the branches 18 thus separating them radially outwards.

As noted above, the tissue fastener or fastener 10 includes a suture segment 40 and a needle 46. The needle 46 can be of any variety suitable for suturing tissue. However, the preferred needle 46 is a surgical member 46 for making incisions of the type indicated in US Pat. 5,569,301. When the surgical member 46 is used to make incisions, it is advantageous to use a particular suture apparatus described in US Pat. 5,569,301. The suture apparatus 250 generally includes a handle portion 252 having a pair of pivoting handles 254 fixed thereto. An elongate member 256 extends distally from the handle portion 252 and ends in a pair of movable jaws 258 and 260. The operation of the handles 254 opens and closes the jaws 258 and 260. As described in US Pat. No. 5,569,301, the operation of a flip-flop lever 262 serves to securely and releasably secure the surgical member 46 to make incisions inside jaws 258 and 260. Thus, when closing handles 254, jaws 258 and 260 are they close and cause the surgical member 46 to make incisions to penetrate the tissue between them and it can be done, by operating the flip-flop lever 262, that the surgical member 46 to make incisions, be released from a first jaw and secured in a second jaw , in order to thus pass the needle through the tissue when the jaws 258, 260 are opened.

Referring now to fig. 6 the use of the fastener or fastener 10 for tissue will be described in order to secure a piece of tissue, such as muscle tissue, relative to a bone. While this exposure finds a wide range of applications in any situation where muscle tissue, ligaments or other soft tissue has to be secured to a bone, the following description is made in terms of securing tissue next to a hole drilled in a bone , as in typical surgical operations of the shoulder. As shown in fig. 6, the suture apparatus has been operated to pass the surgical member 46 to make incisions and a part of the associated segment of the suture 40 through a section A of tissue. As described more fully in U.S. Patent No. 5,569,301, this is achieved by placing the surgical member to make incisions in position in the jaw 258, operating the suture apparatus 250 to close the jaws 258 and 260 in order to pierce the tissue section A with the surgical member 46 to make incisions and by operating the surgical suture instrument to release from the upper jaw 258 the surgical member 46 to make incisions and securely hold it in the lower jaw 260 so that, when opening the jaws 258 and 260, the member is pulled Surgical 46 for making incisions and for the part of suture 40 through section A of tissue.

Referring now to fig. 7, in order to secure the section A of tissue to the distal end of the armed pin 24, the suture apparatus 250 is again operated to pass the surgical member 46 to make incisions through the transverse hole 50 of the bulbous part 34 of the armature pin 24. By manipulating the surgical suture apparatus 250, tension can be applied to the suture 40 in order to pull the section A of tissue to carry it tightly against the distal end of the armature pin 24.

Referring now to fig. 8, in order to secure a section of tissue and pull it to carry it along a particular section of bone, a hole B is drilled in the desired section of bone C of the shoulder. Once a hole B has been drilled in the bone C, the implantation apparatus 200 can be manipulated in order to position the non-activated tissue fastener or fastener 10 with a length of the fabric A secured next to he, inside hole B.

Referring to figs. 8-10, the actuation of the implantation apparatus 200 leads to a pair of pusher teeth 212 through the access chamber 116 of the mounting member 100 applied with the head 16 of the expandable member 12 and, thus, leads to the expandable member 12 distally in relation to the mounting pin 24. The mounting member 100 may have an access chamber 116 narrowed towards the center of the member 100 to allow use with existing instrumentation and for application with the head 16 of relatively small diameter of the expandable member 12. As noted above, when the fastener or tissue holder 10 is loaded into the mounting member 100, the head 32 of the armed pin 24 cannot make movements. Thus, when the teeth carry the expandable member 12 distally, the distal ends of the branches 18 are in application with the cam-acting surface 36 of the armed pin 24 and are driven radially outward. As indicated above, the fins 28 are applied in grooves 20 formed in the expandable member 12 and guided by them. As the branches 18 are carried radially outwardly, the harpoons 22 are applied with a part of the suture 40 and secured against the bone C inside the hole B. Alternatively, the section A of tissue can be introduced into the hole B before expanding the expandable member 12. As described above, when sufficient force has been applied to the expandable member 12 by means of the pusher teeth, the expandable member 12 cannot advance further in relation to the armed pin 24 and the additional force cuts or breaks the armed pin 24 through the break notch 52.

As shown in fig. 9, after actuation, the armed pin 24 is disposed inside the head 16 of the expandable member 12. In this way, the section A of tissue is secured next to the opening of the bone hole C. Suture 40 is Stress enough that section A of tissue is out of the hole. Thus, tension can be applied to the suture 40 in order to tighten one end of the tissue section adjacent to the fastener or fastener 10 for tissue without pulling it into the hole. The action of the expandable member 12 secures and locks in place the suture inside the hole B, thus facilitating the fixation of the tissue section without the need for any external knot. Thus, it is a convenient, safe and easy procedure to fix a suture without knots.

Referring now to fig. 11, the use of the fastener or fastener 10 for tissue in the repair surgery of the ligaments of a knee will be described below, when it is desirable to secure a distal end of a ligament within an elongated hole drilled in a bone of knee. As indicated above, this is often achieved by threading a screw next to the ligament, which leads to abrasion of the ligament or wedging the ligament together with some type of wedge in the hole, in which case the ligament must travel a longitudinal distance, while suffering abrasion with the bone on one side and with the wedge on the other. The described method has the clear advantage of making it possible to position a section of ligament in a hole in a knee bone without causing trauma to the ligament.

As shown in fig. 11, initially the surgical suture apparatus 250 is operated, and this in order to pass the surgical member 46 to make incisions and, also, to the suture 40 through section D of the ligament. Preferably, the surgical member 46 for making incisions is passed several times to one side and to the other through the ligament section D in order to achieve a secure retention of the ligament D with the suture 40.

Referring now to fig. 12, the section D of the ligament is advanced along the suture 40 towards the sharp tip 38 until the perforated section of the ligament D is next to the sharp tip 38. Next, in order to securely secure the section D from the ligament to the armed pin 24, the suture apparatus is operated to pass the surgical member 46 to make incisions through the transverse hole 50 of the armed pin 24. The suture can then be wrapped several times around the bulbous part 34 and ligament D to thus tie ligament D to the distal end of the spigot 24.

Subsequently, the disposable loading unit 150, which contains the ligament D attached, is mounted in the implantation apparatus as described above.

Referring now to fig. 13, once the disposable loading unit 150 and the apparatus 200 have been mounted, the implantation apparatus 200 is placed in a position such that the elongate part 202 and the fastener or fastener 10 for tissue are advanced through of holes E and F drilled through the bones G and H of the knee joint. Specifically, in fig. 13 the holes E and F through the bone sections of the knee are illustrated with a sufficient diameter, such that the elongate portion 204 can be passed therethrough. However, due to the reduced diameter of the fastener or fastener 10 for tissue and ligament D, it is not subjected to any trauma when advanced through the bones E and F. At the end of the hole F a hole is drilled. hole I of smaller diameter to accommodate them. The point at which the implant is to expand is the hole I of reduced diameter.

Referring to figs. 13 and 14, the actuation of the implantation apparatus 200 will serve to push the expandable member 12 distally in relation to the armed pin 24, thereby forcing the branches 18 radially outwardly to be applied with section D of the ligament next to the bone G and secure it. Thus, ligament D is firmly secured inside hole F without any suture and without causing any trauma to ligament D, not being necessary, nor tie any knot.

It will be understood that various modifications can be made to the embodiments described herein. For example, the harpoons 22 of the expandable member 12 may be reconfigured as surfaces subjected to abrasion or other means for frictionally applied with the suture 12 when they are moved with cam action against the suture 12 in a hole in a bone. In addition, the harpoons 22 may adopt a rounded configuration to be less traumatic for any section of tissue or ligament associated in application with the branches 18 when they expand. The foregoing description should not be considered as limiting but simply as illustrative of preferred embodiments. Other modifications will occur to those skilled in the art within the scope of the appended claims.

Claims (12)

1. An anchor (40) without knots for fabric, comprising: an expandable member (12) that defines an bore (15) therethrough and that includes a part (18) that can expand radially; an inner member (24) disposed to slide in the bore of the expandable member such that the expandable portion expands radially outward in response to a longitudinal movement of the expandable member relative to the inner member; a suture segment (40) having a first end (42) and a second end (48), the first end of the suture being fixed to the distal end of the inner member; Y characterized because The second end of the suture segment is fixed to a surgical needle (46) intended to pass the suture through a tissue, and a distal part of the inner member is provided with a transverse hole (50) with a diameter intended to allow that the surgical needle and the suture pass through it in order to secure the tissue adjacent to the distal end of the inner limb.

2.

 The knotless anchor for fabric as claimed in claim 1, wherein the expandable portion includes at least two flexible branches (18).

3.

 The knotless anchor for fabric as claimed in claim 2, wherein the inner member has a cam action surface (36) configured to be applied with said at least two flexible branches to force the ends of said branches to move radially out in response to a relative longitudinal movement between the expandable member and the inner member.

Four.

 The knotless anchor for fabric as claimed in claim 3, wherein the cam action surface is configured to be applied with said at least two branches in response to the distal movement of the expandable member relative to the inner member.

5.

 The knotless anchor for tissue as claimed in any one of the preceding claims, wherein the needle is a member for making incisions, double pointed and the second end of the suture is fixed to the needle between the tips.

6.

 The knotless anchor for fabric as claimed in claim 2 or in any one of claims 3 to 5 when dependent on claim 2, wherein said at least two flexible branches define at least two grooves (20) between them, the inner member having at least two fins (28), each of said at least two fins being configured to be received by sliding in a corresponding slot of said at least two grooves.

7.

 The knotless anchor for fabric as claimed in any one of the preceding claims, wherein the inner member has circumferential ridges (30), the ridges being able to be applied with the expandable member to prevent distal movement of the inner member relative to the member expandable after the expandable part has been expanded radially.

8.

 The knotless anchor for fabric as claimed in claim 2 or in any one of claims 3 to 6 when dependent on claim 2, wherein said at least two flexible branches have ridges (30) on their outer surfaces to be applied. with friction with the surrounding bone.

9.

 The knotless anchor for fabric as claimed in any one of the preceding claims, wherein the expandable member has an enlarged head (16) at a proximal end thereof.

10.

 The knotless anchor for fabric as claimed in any one of the preceding claims, wherein the first end of the suture segment is fixed to the distal end of the inner member by holding it inside a hole (44) in a sharp point (38) of the internal member.

eleven.

 The knotless anchor for tissue as claimed in any one of the preceding claims and a mounting member (100) configured to releasably receive the knotless anchor for tissue for use with a surgical implantation apparatus, comprising:

a rod (106) having a structure (108) for releasable application, with a corresponding structure of the implantation apparatus, the rod having at least one longitudinal access chamber (116) to receive a drive structure associated with the implantation apparatus. 12. The knotless anchor for tissue and the mounting member as claimed in claim 11, wherein the rod has a mounting structure (104, 110) at a distal end thereof to be releasably applied with the expandable fabric anchor, such that the combined mounting member and fabric anchor, form a disposable loading unit.